Tourette's%20syndrome%20-and-%20other%20tic%20disorders Diagnosis
Diagnosis
- There are 3 types of tic disorders based on DSM-5 criteria
Tourette's Disorder
- Presence of both multiple motor tics and at least 1 vocal tic during the course of illness, although they may not occur at the same time
- The tics may increase and decrease in frequency but have continued for >1 year since the first tic occurred
- Tics started before 18 years of age
- Symptoms are not due to effects of any substance (eg cocaine) or caused by any other medical condition (eg Hungtington’s disease or postviral encephalitis)
- Presence of either one or more motor or vocal tics during the course of the illness
- The tics may increase and decrease in frequency but have continued for >1 year since the first tic occurred
- Tics started before 18 years of age
- Symptoms are not due to effects of any substance (eg cocaine) or caused by any other medical condition (eg Hungtington’s disease or postviral encephalitis)
- The patient has not been diagnosed with Tourette’s disorder
- Specify if the disorder has motor tics only or vocal tics only
- Presence of one or more motor and/or vocal tics
- The tics persisted for <1 year since the first tic occurred
- Tics started before 18 years of age
- Symptoms are not due to effects of any substance (eg cocaine) or caused by any other medical condition (eg Hungtington’s disease or postviral encephalitis)
- The patient has not been diagnosed with Tourette’s disorder or persistent (chronic) motor or vocal tic disorder
Classification
- Tics may be classified based on:
- Type
- Motor: Fragments of normal motor movements appearing out of context and arise in the voluntary musculature involving discrete muscles or group of muscles
- Vocal or phonic: Noise produced by movement of air through the nose, mouth or pharynx
- Sensory: These are premonitory sensations that precede tics characterized as unpleasant somatosensory sensations and often relieved by execution of the tic
- Cognitive: These are repetitive thoughts that occur as a response to excessive urge to act upon provocative visual, auditory, tactile or inner stimuli, often called as impulsions
- Complexity - simple or complex
- Isolated (same anatomical location) or multiple locations
- Location, number, frequency
- Duration
- Clonic: Tics are <100 milliseconds
- Dystonic: Tics are >300 milliseconds, characterized by abnormal posture
- Tonic: Tics are >300 milliseconds, characterized by isometric contraction
- Type
Simple Tics
- Simple motor tics are restricted to a single or a few muscle groups and last less than a fraction of a second
- Eg eye blinking, nose wrinkling, neck jerking, shoulder shrugging, facial grimacing, abdominal tensing
- Simple vocal tics are elementary sounds
- Eg throat clearing, grunting, sniffling, snorting
Complex Tics
- Complex motor tics involve larger muscle groups, usually last longer, and appear purposeful and goal-directed
- Eg Copropraxia (repetitive obscene movements), echopraxia (mimicking others), self-injurious behavior, hand gestures, jumping, pressing, stomping, facial contortions, repeatedly smelling an object
- Complex vocal tics occur when sounds are elaborate or have a semantic content
- Eg Palilalia (repeating one’s own words), echolalia (repeating another’s words or phrases), coprolalia (use of obscene words)
Common Comorbid Conditions Found in Patients with Tourette's Syndrome
- Attention-deficit/hyperactivity disorder (ADHD)
- Obsessive-compulsive disorder (OCD)
- Learning, developmental & disruptive behavioral disorders
Please see Attention-Deficit/Hyperactivity Disorder & Obsessive-Compulsive Disorder Disease Management Charts for detailed information concerning medications used for treatment